Can anyone help me make sense of these BG numbers?

Clarence & family

Clarence & family

Member Since 2024
My Siamese13 year old kitty Clarence was started on ProZinc two weeks ago right after he was diagnosed with FD. At diagnosis his BG was 531 (29.5 mmol), fructosamine was just under 600.

we started with 1,5U of ProZinc twice daily, and I also switched him fully to LC food.
I’ve put Clarence’s sheet in my signature and I could really use some help making sense of his BG numbers and dosage. He’s bouncing all over the place and despite often high pre shot numbers and what the vet said was a conservative starting dose he went hypo pretty soon into his insulin treatment. I couldn’t get any BG numbers on his first day of prozinc, the vet told me to test by getting blood from his ear, and he’s NOT having that, he goes into a complete panic. Second day I was told to try his feet, and he’s completely fine with that. I got 198 (11 mmol) at +5. Vet said that’s fine, ideally she wants him between 108 - 144 (6 - 8 mmol), but keep him on this dose for a week and then we’ll see if it needs to go up or down.
Third day he was a little quiet and I got 56 at +6! I was told on a Dutch forum to feed him to get his BS up, which it did slowly +7 was 63, +8 was 68 before going down again to 50 at +9. More food and we went to 110, and we ended up at 194 at PMPS time. I was advised to not give him a shot that evening, and do 0.5U the next morning and the two cycles after that.
AMPS after the no shot was 405 and I gave him 0.5U for 3 cycles. During those cycles I tested his BG at pre shot times and between +4 and +7. Every measurement was between 300 - 365ish.
After the three 0.5U cycles I upped to 1U again. That gave us +6’s in the lower to mid blues (110-140) and pre shots around 245-260 for nearly two days, so you’d think we were headed in the right direction. But on the third day of the 1U dose there was the pattern again where the mid cycle measurements were almost the same as the PS ones. Again around the lower to mid 300’s, and then up to a low 400 PMPS.

I decided to start measuring earlier, from +2 with two hour intervals on day 5 of the 1U doses. And I think he’s showing a pretty clear somogyi effect. He started at 376, started to dip at +2 with a nadir of 72 at +4 before rising sharply and ending with a PMPS of 443.
I spoke with the vet who said that it seems 1U is too much and 0.5U too little, so do 0.75. I did and again it seemed to go pretty well for a couple days. Mostly in the lower to mid blues again, although his nadir seems to vary between +4 to +6. I even got AMPS numbers in the higher blues (180).
And then yesterday evening, I suddenly got a PMPS of 437 again… still gave him 0.75, and woke up early this morning to test him, I got 275 at +8. But to my big surprise, I tested him again at AMPS as I always do, and he was at 184?? He did not eat in the time between the +8 and AMPS, I’m 100% sure of that.

Can anyone make sense of this? It seems there’s a very small margin for the right dose for Clarence, he either bounces, has a somogyi effect, or it goes well for a couple days and then his BS rises again.
And what does it mean that his BS dropped as late in the cycle as it did this morning?

edited to add: just tested his BS at +2, it’s 36. Feeding him now and testing again every 20 minutes
 
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First, I am looking at his spreadsheet for right now and see the 36. Please give a couple of drops karo syrup in a teaspoon of food or just straight into his mouth if he won’t eat that. And test again in 20 minutes. Please report the number here.
 
When he’s in the 30s, definitely give corn syrup or honey or pure maple syrup to bring the BG up rapidly. We don’t want to rely solely on food in the 30s, although it is helpful to feed also a teaspoon of high carb food like Fancy Feast Gravy Lovers with it. The karo will wear off pretty quickly so the high carb food will help. Also, please remember to keep the food portions small because you don’t want him to get full and refuse to eat — it could take a while to get him stabilized so it’s best to keep him hungry.
 
Sorry for the late reply, Clarence actually managed to escape through an open back door after I tested him again. Caught him fortunately but took some time.
I gave him some syrup, not only food, sorry I forgot to mention that. He’s up to 4.1 now! And doing well.
 
Oh, that’s scary about him escaping! How many more minutes until your next test? You will need to keep testing and feeding little bits of food to make sure he doesn’t drop back down.
 
Will test again in a couple minutes to see if he doesn’t drop again. Unfortunately he’s one of those cats that shows no symptoms, he was playing with a cardboard box right before I tested him, so I didn’t think anything was wrong, but I’m so glad I decided to test him anyway! He went right back to playing after, I wanted to throw the box out because he kept shredding it and the box was more interesting than food, but when I opened the back door he ran past me into the garden and out the garden gate! Caught him down the street after crawling through a neighbor’s garden….
 
Clarence & family said:
Will test again in a couple minutes to see if he doesn’t drop again. Unfortunately he’s one of those cats that shows no symptoms, he was playing with a cardboard box right before I tested him, so I didn’t think anything was wrong, but I’m so glad I decided to test him anyway! He went right back to playing after, I wanted to throw the box out because he kept shredding it and the box was more interesting than food, but when I opened the back door he ran past me into the garden and out the garden gate! Caught him down the street after crawling through a neighbor’s garden….
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Oh my! He’s giving you the run around (literally) this morning.
 
Last time he went hypo he was also slow to get his numbers up. I’ve put out food for him and he’s walking around being a little turd :confused: because he wants to go outside again. Between yelling at the back door he takes a couple bites of his food every few minutes.
 
Yes it’s a human meter, the freestyle freedom lite (I’m Dutch so not sure if those are known in the US). And I just realized I’m using both the US measurements and the ones we use here mixed up in this thread, apologies! So in US measurements he went from 36 to 76 to now 83 (there were more in between, I’m testing every half hour now).
 
Clarence & family said:
Yes it’s a human meter, the freestyle freedom lite (I’m Dutch so not sure if those are known in the US). And I just realized I’m using both the US measurements and the ones we use here mixed up in this thread, apologies! So in US measurements he went from 36 to 76 to now 83 (there were more in between, I’m testing every half hour now).
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Yes. I believe I have heard of the Freestyle Lite, but I just wanted to be sure. It’s okay about the numbers. I can look at the U.S. tab on your spreadsheet which populates automatically. And as his numbers go up/stabilize you can spread out the times between tests.
 
I’m looking over his whole first weeks of data. He really has been all over the place in his BG numbers. It’s not so unusual to have cats who have just started insulin to be in wacky numbers. It can take time to stabilize them. It’s great that he is allowing you to test him as much as he is - and you are using his paw? I hope you are using the ultra fine lancets.

Technically, he has earned a reduction down to .25 units with the lime green today. Normally, the SLGS protocol would be to hold the reduced dose for one week. I definitely recommend reducing, for safety, because of the lime green. I think he needs to stabilize on a dose of insulin that is shootable.

So you say that he’s completely transitioned to low carb wet food? Tell me, did he eat a good breakfast this morning? Do you know the carb percentage of the food? He really took a dive.
 
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Oh, and another thing— you can put multiple tests into a single cell, but you will have to manually color code the cell and sometimes the background color to make it legible.
 
He’s holding between 80 and 90 and seems to be in a happy mood. He doesn’t want his normal wet food anymore (he’s a really fussy eater), but I’m giving him a small amount of a liquid snack now every half hour or so, and he does want that.
 
Suzanne & Darcy said:
Another question, did he have ketones at diagnosis? Or are you testing for ketones now?
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no ketones at diagnosis, and I have a couple of strips, but I’ve only managed 3 ketone tests, he does not like an audience while peeing apparently, nor the special kitty litter for testing (if I use that he’ll pee against the outside of the litterbox). But all 3 tests showed no ketones.
 
My Siamese cats will eat anything and everything. They are youngsters though. They “sing” for their food and “dance” for it as well. They go up on their hind legs and meow their heads off and go in circles on their hind legs. Then they inhale their food in about one minute. It’s wild.
 
Oh so that’s a young Siamese cat thing? Lol. When Clarence was just an itty bitty kitty we actually had to lock him in the hallway when we were eating dinner! He would go crazy when he saw food, he would literally jump on our plates and I’ve more than once pried a piece of human food out of a tiny growling Clarence’s mouth. I always thought it was because he came from a large litter (9!). His breeder had 2 queens who gave birth only 2 days apart, and the other litter were 7 I think. It was like an avalanche of kitties there, and feeding time was, well, ‘unhinged’.
 
Clarence & family said:
Oh so that’s a young Siamese cat thing? Lol. When Clarence was just an itty bitty kitty we actually had to lock him in the hallway when we were eating dinner! He would go crazy when he saw food, he would literally jump on our plates and I’ve more than once pried a piece of human food out of a tiny growling Clarence’s mouth. I always thought it was because he came from a large litter (9!). His breeder had 2 queens who gave birth only 2 days apart, and the other litter were 7 I think. It was like an avalanche of kitties there, and feeding time was, well, ‘unhinged’.
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I can only imagine feeding time with all those Siamese kittens. And yes, we always shut them in another room when we are eating or we will have no peace!
 
Suzanne & Darcy said:
I’m looking over his whole first weeks of data. He really has been all over the place in his BG numbers. It’s not so unusual to have cats who have just started insulin to be in wacky numbers. It can take time to stabilize them. It’s great that he is allowing you to test him as much as he is - and you are using his paw? I hope you are using the ultra fine lancets.

Technically, he has earned a reduction down to .25 units with the lime green today. Normally, the SLGS protocol would be to hold the reduced dose for one week. I definitely recommend reducing, for safety, because of the lime green. I think he needs to stabilize on a dose of insulin that is shootable.

So you say that he’s completely transitioned to low carb wet food? Tell me, did he eat a good breakfast this morning? Do you know the carb percentage of the food? He really took a dive.
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I completely missed this post! Sorry!

yes I am using his paw, and he’s absolutely great with testing, he doesn’t mind it at all. It helps that he really likes to be held and the poke does not bother him at all IF I used a lancet pen. Freehand is a no no. His insulin injections are a different story unfortunately, he hates those. He’s never bitten or scratched in his life, but he’ll launch himself into the air given the chance.

He’s switched over completely to LC food, but he eats both LC wet food and kibble. The reason for the kibble is that we have another cat with health issues (epilepsy, ataxia and liver problems) who is prone to hepatic lipidosis and will refuse to eat if he does not get free range kibble. The dry food however has a carb percentage of only 4,84%. It’s called Power of Nature.
Clarence however eats mostly wet food and occasionally snacks a bit of kibble. The wet food I vary, but I’ve spent the first 2 days after his diagnosis researching carb content of different brands, nothing I have is above 8%, but most are lower. With the exception of a box of Sheba he really likes for instances like today that is higher in carbs.
This morning he ate nearly a full small can (70 grams, so that’s 2.5 oz?) of Almo nature tuna. I just looked up the carb content and it’s 2,35%.

I’ll do 0.25 units today and see how he does with that. It’s so frustrating seeing his numbers go up again after a few days every time I reduce the dose (but I will reduce, absolutely no worries). I also feel bad I even gave him a shot this morning as apparently he was still dropping (4 hours before AMPS he was at 275, at AMPS he was at 184). Vet said to give him a shot, just reduce the dose slightly, if he’s between 180 - 225.

He’s at 140 now.
 
Clarence & family said:
Vet said to give him a shot, just reduce the dose slightly, if he’s between 180 - 225.
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Yes. This is what I always recommend. It rarely is a good idea to skip a dose completely. They do much better with a reduced dose. I was going to mention that about your skipped dose on July 27 — he went too high with the skip and I would have tried something like .5 units at that point (since his dose was 1.5 at the time.) You would still need to be able to monitor the cycle, of course.
It is super frustrating to see him go back to high numbers, I agree— especially since he’s had a few really great cycles and seen some of the good green numbers.

Since his breakfast was such low carb, you might want to try feeding higher carb to slow down his early dives (8 percent-ish — anything ten percent or less is considered low carb). I usually recommend a +2 snack (and it is a good idea) but today he had already gone onto lime green territory by +2 so I think he would benefit from a few more carbs at breakfast. Of course, yesterday he had a very similar AMPS and he did not dive. So he’s being difficult! :confused:
 
He’s now at 349 for his PMPS, so he went pretty high in response to the very low.

yes, yesterday he had a very similar number and did not dive, but yesterday he was went from 145, 152, 180 in the hours before his morning shot, so his BG was rising, today he went from 275 to 184 in the hours before his shot, so his numbers were going down when they shouldn’t have?

His breakfast this morning was indeed very low carb, I’ll grab one with more carb tomorrow morning and save the ones with very low carbs for more towards the end of cycles.
 
As for the low number this morning, it may have been a bounce break. I hesitate to say that it was a true bounce because he goes high and doesn’t tend to stay there very long — whereas most bounces have a longer period of sustained numbers. It’s really good that he gets back to work with the insulin quickly. When a bounce is breaking there is a lot of downward momentum and when you combine that with an insulin shot kicking in at +2 you had a lime at +2.
 
He sure isn’t insulin resistant. I tested again a couple hours before his shot this morning, a little later than I had planned because I slept through my alarm! Clarence woke me up by dropping one of his toys on my face.
He was at 466 (29.5) this morning at +10, at 407 (22.6) at +11, and his AMPS was 398 (22.1). So again he’s having a high peak in the early morning before dropping a bit. So high numbers and the drop isn’t as much as yesterday, but I think that was to be expected.
He was hungry this morning for the first time since starting insulin. Other than that he seems very happy and active.
 
I was trying to check his spreadsheet for today but there were no entries for today. Then I thought to check the world tab and I saw your entries. For some reason the US tab isn’t populating au like it’s supposed to.

Too bad he stayed in the yellow numbers, but it will be good to see how things go for a little while on this dose. Clarence being hungry is a very good sign! I am happy about it.
 
Oh that’s weird! As far as I know I didn’t touch the US tab. I just updated his sheet again, he was really high at his PMPS, 450! Hungry again and very very active. I fed him and he ate (pretty much inhaled) a 100 gram pouch of wet food. I gave him a 0.25U shot again, which was a struggle, and then he wanted to go outside in the garden (he walks on a leash) and he spent nearly half an hour zooming around and catching bugs. He spent the rest of the evening using me as a pillow and making biscuits. So despite his high numbers he’s happy as a clam. I just checked his +2 and he’s at 284 now.

Oh and I forgot to add, I checked for ketones, 0,2-ish now (very slightly darker than the no ketones colour, but much lighter than the 0.5) and I think that still falls under trace amounts? I’ll keep an eye on it and I think I’ll get a blood ketone meter as that’s going to be a lot easier with him.
 
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Clarence & family said:
Oh that’s weird! As far as I know I didn’t touch the US tab. I just updated his sheet again, he was really high at his PMPS, 450! Hungry again and very very active. I fed him and he ate (pretty much inhaled) a 100 gram pouch of wet food. I gave him a 0.25U shot again, which was a struggle, and then he wanted to go outside in the garden (he walks on a leash) and he spent nearly half an hour zooming around and catching bugs. He spent the rest of the evening using me as a pillow and making biscuits. So despite his high numbers he’s happy as a clam. I just checked his +2 and he’s at 284 now.

Oh and I forgot to add, I checked for ketones, 0,2-ish now (very slightly darker than the no ketones colour, but much lighter than the 0.5) and I think that still falls under trace amounts? I’ll keep an eye on it and I think I’ll get a blood ketone meter as that’s going to be a lot easier with him.
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It sounds like he had a happy day! That’s a little bit better drop in two hours. I hope he will het into a little blue later.
 
Suzanne & Darcy said:
It sounds like he had a happy day! That’s a little bit better drop in two hours. I hope he will het into a little blue later.
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I wasn’t able to do mid cycle checks as I really needed my sleep, I’m a bit exhausted (not only from Clarence). +10 after I woke up was 410.
He gets his insulin around 10 AM/PM (I think there’s a 6 hr time difference between us).
 
Got a bit of a scare this morning, checked his BG this morning at +9 which was 448 (24.9), and at AMPS the reading was HI!
It has now dropped to 398 (22.1) at +3.

I’m a bit at a loss, 0.5U brought him into hypo territory and with 0.25U he stays way too high
 
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I was traveling all day yesterday (returning home from vacation) and am now getting caught back up. Do you have any more data to put into the spreadsheet for August 10? What is a .4 dose? How did you measure it? Is it just what we would call a skinny .5 units (where you just shave a little off of the .5 units— just eyeballing it?) If Clarence were my cat, I would go ahead and raise his dose back up to .5 units as long as I could give higher carbs for breakfast and at his +2 snack and as long as I could keep testing frequently. With the food modifications, he won’t necessarily have the same reaction to the .5 units as last time.
 
Hi, I’m very sorry for the lack of updates! I found myself in a rather unfortunate personal situation with no access to my old phone, tablet or even the cloud, so I couldn’t do any updates. Getting back on my feet now, all is going to be well.
I did manage to keep up with the vet, either myself ir through family and got advise through them as much as possible. And I did keep a notebook with all of Clarence’s data, I’ve updated the spreadsheet.

Clarence has had a bit of ups and downs, he’s on a significantly higher dose now, but his numbers are still all over the place. He’s feeling great though, other than peeing and drinking a lot more when he’s in high numbers there are no noticeable changes in his behavior and he seems very happy and active.

I still don’t really know what to make of his numbers and if I’m doing the right thing. With every dose change he seems to start pretty good or even dip too low before creeping up again.
The vet has really helped with his dosage, but they keep trying to tell me his numbers are so erratic because he isn’t fed diabetic food and because he gets multiple brands/types of food. That last bit is true, but they’re all low carb.
For the past week I’ve fed him the same wet food every day to see if they were right, but as you can see it doesn’t seem to make a difference.
 
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Whew. I was just worried that something bad had happened to you or Clarence.

Do not increase his dose any more right now. He’s not doing too badly, but he’s very bouncy. It just takes time (sigh.) right @Shawn & Sir Maximus ? I helped Shawn with his boy Sir Maximus who is now very stable on a small dose of ProZinc, but there for a while he was really bouncy and it was making Shawn kind of crazy.

In fact, with the 88 you caught today he has earned a reduction down to 1.25 units, but you may just want to leave him at his current dose and follow the protocol of the Modified ProZinc method where reductions are taken when kitty drops below 50. It’s a way to get him used to the lower numbers more quickly.
 
Suzanne & Darcy said:
Whew. I was just worried that something bad had happened to you or Clarence.

Do not increase his dose any more right now. He’s not doing too badly, but he’s very bouncy. It just takes time (sigh.) right @Shawn & Sir Maximus ? I helped Shawn with his boy Sir Maximus who is now very stable on a small dose of ProZinc, but there for a while he was really bouncy and it was making Shawn kind of crazy.

In fact, with the 88 you caught today he has earned a reduction down to 1.25 units, but you may just want to leave him at his current dose and follow the protocol of the Modified ProZinc method where reductions are taken when kitty drops below 50. It’s a way to get him used to the lower numbers more quickly.
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Yes I starting to wonder if I would ever get my boy's numbers into a healthy range. He was up n down like a roller coaster but i just had to give him time and then one day boom his body adjusted to being in the lower numbers. Just be patient and consistent and it will all work out for him. I have a lot posts back in the day with my journey with Suzanne going thru all the craziness of him bouncing and how she guided me. Good luck and wish you both the best!
 
Suzanne & Darcy said:
Whew. I was just worried that something bad had happened to you or Clarence.

Do not increase his dose any more right now. He’s not doing too badly, but he’s very bouncy. It just takes time (sigh.) right @Shawn & Sir Maximus ? I helped Shawn with his boy Sir Maximus who is now very stable on a small dose of ProZinc, but there for a while he was really bouncy and it was making Shawn kind of crazy.

In fact, with the 88 you caught today he has earned a reduction down to 1.25 units, but you may just want to leave him at his current dose and follow the protocol of the Modified ProZinc method where reductions are taken when kitty drops below 50. It’s a way to get him used to the lower numbers more quickly.
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no I don’t want to increase his dose any further, vet suggested to go to 2.0,U but I’m sure he’ll crash if I do that. Fortunately he seems to be feeling absolutely fine with low numbers, I’d say he’s a bit more lethargic (although nothing extreme) when he’s very high. The only time he showed some altered behavior was when he had the 36 glucose reading. He acts perfectly normal with BG in the 70’s.
 
Shawn & Sir Maximus said:
Yes I starting to wonder if I would ever get my boy's numbers into a healthy range. He was up n down like a roller coaster but i just had to give him time and then one day boom his body adjusted to being in the lower numbers. Just be patient and consistent and it will all work out for him. I have a lot posts back in the day with my journey with Suzanne going thru all the craziness of him bouncing and how she guided me. Good luck and wish you both the best!
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Thank you for your reply! Good to know that it can stabilize even if they’re this bouncy. I read through your posts, maybe it will put my mind at ease a bit.
 
Clarence & family said:
no I don’t want to increase his dose any further, vet suggested to go to 2.0,U but I’m sure he’ll crash if I do that. Fortunately he seems to be feeling absolutely fine with low numbers, I’d say he’s a bit more lethargic (although nothing extreme) when he’s very high. The only time he showed some altered behavior was when he had the 36 glucose reading. He acts perfectly normal with BG in the 70’s.
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Definitely do not increase now. You have green nadirs (like today) and 2 units will put him in danger (based on spreadsheet data.). Cats’ insulin needs can and do change over time - up or down- and that’s why we don’t get complacent and stop testing. So for now anyway, no increase is warranted.
 
Unfortunately he is going up to very high numbers again after holding the 1.5U dose for a week…. The glucose meter I normally use only goes up to 27.7 (500) after that it’s HI, and if I get that I have another one one that goes up to 33.3 (600). I even got a HI on that one this morning, so he goes over 600. I’ve also tested for ketones and it’s showing trace ketones now. Should I up the dose or wait a little longer?
 
Luckily he seems to be feeling fine, still playing lots and very active, but I do see he’s drinking and peeing very much again.
Thanks you, I’ll increase the dose tonight and set an alarm a couple times. Fortunately he’s such an easy cat when it comes to checking blood glucose, he doesn’t mind it at all.

and yes, it’s frustrating, especially because halfway through the week of holding the 1.5U dose he seemed to be heading in the right direction, and even dips very low, but he keeps going up again. I must say he shows no hypo symptoms when he is low though.
 
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He wouldn’t show symptoms with the 88 or the 77 (8/31 and 8/28) that he had recently. Normal glucose numbers for a cat are between about 50 to a maximum of 120, although I do test my non-diabetic cats at times and get 40s. Of course, we don’t want him below 50 because of the influence of the insulin. If you have more greens in that 70-80 range then just give a small amount of low carb wet food and if you’re worried then retest in 30 minutes to see if numbers are stable or rising. Everyone gets nervous (or even panics) when seeing greens that they haven’t seen before or rarely see.
 
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